Endocrinol Metab.  2019 Dec;34(4):406-414. 10.3803/EnM.2019.34.4.406.

Impact of the Dynamic Change of Metabolic Health Status on the Incident Type 2 Diabetes: A Nationwide Population-Based Cohort Study

• Kim JA
• Kim DH
• Kim SM
• Park YG
• Kim NH
• Baik SH
• Choi KM
• Han K
• Yoo HJ

• KMID: 2466260
• DOI: http://doi.org/10.3803/EnM.2019.34.4.406

Abstract

BACKGROUND
Metabolically healthy obese (MHO) is regarded as a transient concept. We examined the effect of the dynamic change of metabolic health status on the incidence of type 2 diabetes mellitus (T2DM) both in obese and normal weight individuals.
METHODS
We analyzed 3,479,514 metabolically healthy subjects aged over 20 years from the Korean National Health Screening Program, who underwent health examination between 2009 and 2010, with a follow-up after 4 years. The relative risk for T2DM incidence until the December 2017 was compared among the four groups: stable metabolically healthy normal weight (MHNW), unstable MHNW, stable MHO, and unstable MHO.
RESULTS
During the 4 years, 11.1% of subjects in the MHNW group, and 31.5% in the MHO group converted to a metabolically unhealthy phenotype. In the multivariate adjusted model, the unstable MHO group showed the highest risk of T2DM (hazard ratio [HR], 4.67; 95% confidence interval [CI], 4.58 to 4.77). The unstable MHNW group had a higher risk of T2DM than stable MHO group ([HR, 3.23; 95% CI, 3.16 to 3.30] vs. [HR, 1.81; 95% CI, 1.76 to 1.85]). The stable MHO group showed a higher risk of T2DM than the stable MHNW group. The influence of the transition into a metabolically unhealthy phenotype on T2DM incidence was greater in subjects with aged <65 years, women, and those with weight gain.
CONCLUSION
Metabolically healthy phenotype was transient both in normal weight and obese individuals. Maintaining metabolic health was critical for the prevention of T2DM, irrespective of their baseline body mass index.

Keyword

Obesity; Metabolic syndrome; Diabetes mellitus, type 2

MeSH Terms

Body Mass Index
Cohort Studies*
Diabetes Mellitus, Type 2
Female
Follow-Up Studies
Healthy Volunteers
Humans
Incidence
Mass Screening
Obesity
Phenotype
Weight Gain

Figure

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  Fig. 1 Study flow sheet. CVD, cardiovascular disease.

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  Fig. 2 Cumulative incidence of type 2 diabetes according to body phenotype and metabolic stability. MHNW, metabolically healthy normal weight; MHO, metabolically healthy obese.

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  Fig. 3 Hazard ratio (HR) and 95% confidence interval (CI) for the incidence of diabetes according to body weight change in the subjects with unstable metabolically healthy normal weight (MHNW) versus stable MHNW and in the subjects with unstable metabolically healthy obese (MHO) versus stable MHO. The reference group contains subjects who remained metabolically healthy over a 4-year follow-up, stable MHNW and stable MHO.

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